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Population Health and Case Management Use Case: Use Case Components
Identify Cases or Possible Cases- what data is needed, how to enter patients into the workflow - 4
Table 1. COVID-19 Risk Factors / Co-morbidities / Past Medical History
Demographics | Elderly population |
Cardiology | Cardiovascular disease (e.g. Hypertension) |
Pulmonology | Asthma, COPD |
Gastroenterology | Liver disease |
Endocrinology | Diabetes |
Nephrology | Chronic kidney disease |
OBGYN | Pregnancy |
Other | Immunocompromised Status (corticosteroid use, transplant status, cancer, chemotherapy, etc.) |
Request for visit (COVID-19 pandemic timeframe) with chief complaint or symptoms matching the following:
Table 2. COVID-19 Symptoms
Dyspnea / shortness of breath
| Sore throat and related pharyngeal symptoms (odynophagia, dysphagia, hoarseness) |
Anosmia / Loss of smell
|
Fever | Headaches | Ageusia / Loss of taste |
Cough | Chills | Muscle aches |
Fatigue | Anorexia / Poor appetite | Nausea / Vomiting / Diarrhea
|
Table 3. COVID-19 Severe Signs and Symptoms [Disposition A]
Severe dyspnea / shortness of breath at rest | Oliguria / decreased urine output |
Severe difficulty in breathing | Hemoptysis / blood in the sputum |
Moderate – severe chest pain or pressure | Nuchal rigidity / stiff neck |
Cold, clammy, pale or mottled skin | Acute onset of confusion |
Cyanosis of extremities or mucous membranes |
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Exposure and Contact Tracing
“Have you had contact with someone who has or was told they may have COVID-19?”
“In the last month, have you or any close contact of yours worked in any health care setting or other essential industry like a grocery store or industrial plant?”
“Do you or anyone you have had close contact with recently stay in a nursing home, jail or prison, other institution or been homeless?”
Follow up contact exposure and tracing:
“Was the contact you had with this person using strict social distancing, meaning did you stay more than 6 feet away at all times or did you wear a mask during all of your contacts?”
If social distancing was followed in all the contacts, the patient should be considered negative.
Inputs into the PopHealth/Case Management system:
Phone or in person screening by the clinic
Patient comes in with symptoms
Hospital or external facility referral
Referred by health department as exposed to a positive patient
Telehealth visit or virtual message from patient
Routine surveillance
Anonymous notification from an exposure notification system
Referred as possibly exposed due to physical proximity to a positive patient?
Data Needed to Determine Status:
Symptoms: * research screening scoring-- speak to UPenn, ED/Inpatient team, consider how to deal with changing symptoms over time
COVID-19 symptoms + (with scoring or severity?)
Fever
Cough
SOB
Other symptoms?
No known symptoms
Symptoms have resolved
Exposure:
High risk settings (use the phone screening criteria to start)
Known positive contact
Anonymous exposure notification
No known high risk settings or positive contacts
Diagnostic Testing Performed:
Test specimen
Test date
Test product
Test location
Test result
Test pending
Test negative
Test positive
Inconclusive test
History of Positive Diagnostic Test?
Antibody Testing:
History of Positive Antibody Test?
Patient Identifiers and Contact Information:
Name
Address-- physical, facilities
Status:
Patient needs evaluation from a medical professional
Need for testing
Patient tested positive
Issues for Follow Up:
Deduplication-- failure to identify same patient across encounters
Need for accurate contact information
Order and complete testing- order sets, CDS to suggest testing, instructions and referrals for tested patients, quarantine instructions - 2
Follow up test results and referrals – receipt of test results internal or external, other required follow up - 3
Case Reporting and Contact Tracing - eCR, paper reporting, contact identification, contact follow up - 2
Risk Calculation or Stratification - tools to evaluate risk and respond to high risk patients, need for social and medical services to keep patients healthy in quarantine - 2
Update Case Status--> Initiate Outpatient Case Monitoring of Positive or Probable Cases in Quarantine - 4
Inpatient/Outpatient handoffs - coordinate with ED/Inpatient group -
Convalescence - follow up testing, clinical research and plasma donation, identification of presumed low risk for future clinical activities - 1
Great Public Health Medical Center has arranged to start testing patients and employees for SARS-CoV-2 to assist with the public health crisis. They have had many patients who were suspected for COVID-19 and several who tested positive and either quarantined at home or were hospitalized and released. Two patients have died in the hospital so far. They are attempting to begin tracking both the patients who call in with suspected symptoms or exposures, testing those, and following up both on test results done on site and on those resulted from the public health department. They will perform contact tracing via phone as well and contact their own patients who a patient identifies as a contact if appropriate and send this data to the health department for both locations and individuals who are deemed at risk. The Medical Center needs a dashboard that allows them to assign follow up actions to the care team and schedule these as well as a method to follow up on pending tests.
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